The influence of comorbidity and other health measures on dental and medical care use among Medicare beneficiaries 2002

Objective: To assess the impact of comorbidity and other health measures on the use of dental and medical care services among the community-based Medicare population with data from the 2002 Medicare Current Beneficiary Survey. Methods: A comorbidity index is the main independent variable of our study. It includes oral cancer as a comorbidity condition and was developed from Medicare claims data. The two outcome variables indicate whether a beneficiary had a dental visit during the year and whether the beneficiary had an inpatient hospital stay during the year. Logistic regressions estimated the relationship between the outcome variables and comorbidity after controlling for other explanatory variables. Results: High scores on the comorbidity index, high numbers of self-reported physical limitations, and fair or poor self-reported health status were correlated with higher hospital use and lower dental care utilization. Similar results were found for other types of medical care including medical provider visits, outpatient care, and prescription drugs. A multiple imputation technique was used for the approximate 20 percent of the sample with missing claims, but the resulting comorbidity index performed no differently than the index constructed without imputation. Conclusions: Comorbidities and other health status measures are theorized to play either a predisposing or need role in determining health care utilization. The study's findings confirm the dominant role of these measures as predisposing factors limiting access to dental care for Medicare beneficiaries and as need factors producing higher levels of inpatient hospital and other medical care for Medicare beneficiaries.